Citation Nr: 18149296 Decision Date: 11/09/18 Archive Date: 11/09/18 DOCKET NO. 15-33 088 DATE: November 9, 2018 ORDER Entitlement to a permanent and total disability rating for posttraumatic stress disorder (PTSD) is granted. FINDING OF FACT The probative evidence of record supports a finding that the Veteran’s PTSD is permanent and totally disabling. CONCLUSION OF LAW The criteria for entitlement to a permanent and total disability rating for PTSD have been met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. § 3.340 (2017). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had active military service in the U.S. Army from November 1997 to March 1998, January 2004 to August 2004, and from May 2007 to October 2007. The Veteran testified at a video conference hearing in October 2018. As a full grant of the benefits sought on appeal is apparent from the evidence provided, the Board may proceed to adjudicate this claim under the One Touch Program which allows adjudication before the hearing transcript is prepared and attached to the record. 1. Entitlement to a permanent and total disability rating for PTSD Entitlement to a permanent total disability rating requires a Veteran’s disability to be both permanent and total. 38 C.F.R. § 3.340. Pursuant to VA regulations, a total disability may be established in two ways. First, total disability will be considered to exist when there is present any impairment of mind or body which is sufficient to render it impossible for the average person to follow a substantially gainful occupation. 38 C.F.R. § 3.340(a)(1). Second, a total disability may also be assigned where a Veteran’s service-connected disabilities are rated 100 percent disabling under the rating schedule. 38 C.F.R. § 3.340(a)(2). Permanence of total disability will be taken to exist when such impairment is reasonably certain to continue throughout the life of the disabled person. 38 C.F.R. § 3.340(b). Diseases and injuries of long standing which are actually totally incapacitating will be regarded as permanently and totally disabling when the probability of permanent improvement under treatment is remote. Id. The age of the disabled person may be considered in determining permanence. Id. In the instant matter, service connection is in effect for PTSD. It is presently rated at 30 percent beginning October 19, 2007, and 100 percent from May 11, 2009. The Veteran asserts that his current and future prognosis is poor and there is no likelihood of improvement, and rather his condition has continued to worsen. Specifically, the Veteran reports increased irritability with periods of violence, suicidal ideation, memory issues, and severe anxiety and depression. VA treatment records note that the Veteran was hospitalized for psychiatric treatment in May 2009. Upon examination in September 2009, the examiner stated that the symptoms affect the Veteran’s total daily functioning and cause a major impact on his activities. Additionally, the examiner stated that there have been major changes since the Veteran’s diagnosis, including a significant decline resulting a poor prognosis. The Veteran was again hospitalized in April 2010 for suicidal ideation. An August 2014 VA examination similarly noted that the Veteran had “very little quality to his life, very little hope for his future.” Shortly after in December 2014, the Veteran continued arguing that his 100 percent rating should be permanent based on his evaluation beginning in 2009, and his consistent level of disability. A private letter submitted in March 2018, from the Veteran’s caretaker whom had worked with him for approximately three years and had seen his severe anger, aggression, suicidal and homicidal ideation, in addition to his physical disabilities severely impact his daily activities. The caretaker stated that the Veteran’s psychiatric condition had not gotten any better, but rather considered it deteriorating. In her professional opinion, the Veteran would need assistance for the remainder of his life, and despite treatment there was nothing that would change his condition. An October 2018 statement was submitted by a social worker who was familiar with the Veteran’s medical history. In the statement, the social worker stated that the Veteran’s condition had significantly worsened despite participating in over seven years of treatment. The Veteran still experienced increased periods of violence, an inability to comprehend actions or speech, issues with authority, and financial competency. Based on this assessment, the social worker concluded that there is no reason for the Veteran’s symptoms to improve; he has had the condition for many years and the illness has only worsened despite treatment. In an additional October 2018 statement, the Veteran’s counseling psychologist provided an opinion similar to the social workers’; stating that after reviewing previous psychiatric reports, the Veteran’s medical history, and a clinical interview, the Veteran’s severe psychiatric condition will likely not improve regardless of treatment. Moreover, the Board notes that the agency of original jurisdiction (AOJ) denied the Veteran’s claim in part, based on the notion that due to his early age, and continued commitment to treatment, including pharmacology, the evidence failed to establish his inability to cope or permanency of his condition. However, the opinions of permanency by the Veteran’s substantially outweighs any consideration of age in this case. Thus, based on the foregoing, and resolving all doubt in the Veteran’s favor, the Board finds that the most probative evidence of record demonstrates that total impairment from the service-connected psychiatric disability is reasonably certain to continue throughout the Veteran’s life, with a poor to no prognosis of improvement. Thus, a permanent and total disability rating is warranted. See 38 C.F.R. § 3.340. T. MAINELLI Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD J.L. Reid, Associate Counsel